Rhode Island Health
Home Initiative
NASHP 24th Annual State Health Policy Conference,
October 4, 2011
Deborah J. Florio, Administrator
Medicaid Division
Rhode Island Executive Office of Health and Human Services
Why These Populations?
 Both populations (CYSHCN and SPMI) have
complex medical, behavioral health and
psychosocial needs
 Both are at greater risk of developing secondary
conditions than the general Medicaid population
 Both have higher utilization of Emergency
Department and Inpatient Care
 7,000+ adults with SPMI and 12,000+ CYSHCN
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Why These Populations
(cont’d)
 Some Infrastructure already in place

Community Mental Health Centers (CMHOs)
(Adults with SPMI)

CEDARR Family Centers (CFCs) (CYSHCNs)
 Opportunity for further innovation
 Promote natural transitions between child
and adult systems of care
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Other Opportunities
 Harness unique capabilities of CMHOs
and CFCs “boots on the ground”
 Enhance connections between Health
Homes and PCPs and specialists
 Take advantage of data collected by
Medicaid Managed Care Organizations
(MCOs) and Medicare claims to inform
delivery of care
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CEDARR Family Centers for Children and
Youth with Special Health Care Needs
 Comprehensive, Evaluation, Diagnosis,
Assessment, Referral and Re-evaluation
 Started in 2000
 Teams led by Licensed Clinicians (LICSW, RN,
Psychologist)
 Family Centered Practice Approach
 Statewide Coverage
 95% of work done in Child’s home or in a
community setting
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History of CEDARR
 Launched as part of a broader initiative to
address the needs of CSYHCN and their
families
 Broad based stakeholder involvement in
entire development and implementation
process (advocates, family members,
providers, state agencies)
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Goals of the CEDARR Initiative
 Decrease fragmentation within and between the systems
serving children with special health care needs and their
families through care management including the
coordination and integration of services
 Assure that services are provided through a strength-based
and person-oriented system of care
 Support families to their fullest potential and provide direct
services, where necessary
 Assure a flexible and responsive delivery system with
adequate staffing, equipment and educational resources
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CEDARR Today
 Approximately 2,700 children and youth
enrolled at any point in time
 Birth to 21 Years of age
 30% Developmental Disabilities, 50%
Behavioral Health, 20% Physical Health
conditions
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CEDARR Responsibilities
 Assessment of Need
 Identification of, and referral to resources
 Integration of services provided through
different systems (LEA, Medicaid Fee-for
Service, Medicaid Managed Care, Child Welfare)
 Oversight of Medicaid Fee-for-Service
specialized Home and Community based
services
 Re-Assessment and adjustment of Treatment
Plans on an annual basis
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Why CEDARR as a Health Home?
 Required Home Health Services is the core
foundation of CEDARR





Comprehensive Care Management
Care Coordination and Health Promotion
Transitional Services
Individual and Family support
Referral to Community and Social Support Services
 95% of current population meets HH diagnostic
criteria
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Enhancements to CEDARR practice as a
result of Health Homes
 Enhanced screening for secondary conditions
(yearly BMI and Depression screening)
 Additional re-imbursement to PCP’s to engage in
Care Planning and dashboard report developed
to share CEDARR information with PCPs
 Enhanced Information sharing between CEDARR
and Medicaid Managed Care Plans
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CEDARR Rate Development Process
Primary Factors Considered

The average number of hours of effort required of the CEDARR Family Center
service team in order to perform the specific service

The relative contribution to the total effort by various team members

The qualification requirements of various staff members and the associated prevailing wages for
such personnel

Adjustments for the cost of benefits

Adjustments for net efficiency or “billability”

Allocation for overhead
Flat Rates were developed for three CEDARR Services;
 Initial Family Intake and Needs Assessment (IFIND),
 Family Care Plan development (FCP), and
 Family Care Plan Review (FCPR).
IFIND ($366.00)
Travel
Meeting time w/family inc. Work Plan & Crisis Plan
Prep and follow up activities
Total
FCP ($347.00)
Travel
Meeting time w/family
Follow up activities
Plan Development
Total
FCPR ($397.00)
Travel
Meeting time w/family
Follow up activities
Plan Review and Revision
Total
Clinician
($66.50/hr) (Hrs.)
0.75
1.5
1.25
3.5
Clinician
($66.50/hr) (Hrs.)
0.75
1
0
1.75
3.5
Clinician
($66.50/hr) (Hrs.)
0.75
1
0
2.5
4.25
FSC ($38/hr)
(Hrs.)
0.75
1.5
1.25
3.5
FSC ($38/hr)
(Hrs.)
0.75
1
1.25
0
3
FSC ($38/hr)
(Hrs.)
0.75
1
1.25
0
3
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Other CEDARR Services:
Health Needs Coordination: Per 15 minutes of
effort, two rates based upon qualifications


Masters Degree and above- $16.63 per unit ($66.52
per hour)
Less than Masters Degree- $9.50 per unit ($38.00
per hour)
Therapeutic Consultation: Per 15 minutes of
effort, performed by Clinician $16.63 per unit ($66.52
per hour)
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How will we measure
success?
 Traditional Methods

Decrease in ED utilization for ACS Conditions

Reduction in Re-Admissions

Provision of services within required time frames

Medical follow-up after ED visit

HH Services provided within required time-frames

Collaboration between PCP and/or MCO in
development of Care Plan
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How will we measure success?
Cont’d
 Outcomes Based measurements

Child/Youth/Family Satisfaction with service
delivery, content of services, appropriateness of
interventions

Child and Family Outcomes



Knowledge of Condition and available services and
resources
Child’s participation in age appropriate, peer group
activities
Ability of family to engage in “normal family activities”
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Engagement with Federal Partners
 Process followed




SMD Letter issued November 2010
Internal Discussion and Identification of service models
December and January
Draft SPA submitted April 2011
Final SPA submitted August 26
 Federal partnership throughout the process

Multiple conference calls with CMS HH Team on:





Services
Program Design
Rate Methodology
Quality and Measurement
Conference Call with SAMHSA
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Next Steps for Implementation
 MMIS System Modifications
 Amendment to provider standards
 Training of CEDARR Staff
 Outreach to Pediatricians
 Outreach to Acute Care Facilities (Medical and
Psychiatric)
 October 1 start date, concurrent outreach
activities
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Thank you
Questions
Contact Information:
Deborah J. Florio, Administrator
Medicaid Division
(401) 462-0140
dflorio@dhs.ri.gov
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